Lymphatic Swelling in the Neck: Causes and Next Steps

There is lymphatic edema in the left side of the neck?

Hello, doctor.
Three years ago, I discovered lymphatic swelling on the left side of my neck (about five centimeters from the thyroid position, approximately 1.5 times larger than the corresponding lymph node on the right side).
The swelling is fluctuating but not firm; it is not very noticeable externally, but upon touch, I found that the surrounding tissues are also noticeably swollen, which often causes discomfort in my neck.
This swelling has not increased in size over the past three years.
I have undergone blood tests (normal), ultrasound (lymphadenopathy), and nasal endoscopy (normal) every six months, but doctors at three different hospitals have all advised to just monitor it, so I have not undergone any biopsy or CT scans.
At the end of 2016, I had laser treatment for leukoplakia in my mouth (caused by wisdom tooth friction, and the biopsy was normal).
I have wondered if the neck swelling could be a tumor metastasizing to the mouth.
Therefore, I would like to check for esophageal and gastric endoscopy or possibly a biopsy for further diagnosis.
Is this the correct approach, doctor? The swelling has not hardened over three years, and there have been no changes in size, nor have I experienced fever, fatigue, or other symptoms.
Is there a significant chance of lymphoma? Additionally, if it is not cancer, what would be the most suitable treatment for the swelling along the anterior edge of the left neck meridian? Would lymphadenectomy help improve the condition?

Huan, 30~39 year old female. Ask Date: 2016/04/21

Dr. Lai Yicheng reply Oncology

Dear Mr.
Huan,
In response to your inquiry, please find the answers below:
1.
Your concern about "tumors in the neck metastasizing to the oral cavity" is not a phenomenon that occurs clinically.
Additionally, the description of "left cervical lymphatic swelling, mobile but not firm, and not visibly prominent" does not indicate the presence of lymphoma.
2.
Swelling that has persisted for three years without becoming firm, and with no changes in size during this period, along with the absence of symptoms such as fever or fatigue, suggests that the likelihood of lymphoma is low.
Furthermore, even if it is not cancer, what would be the most appropriate treatment for the swelling along the anterior border of the left cervical region? Would lymphadenectomy be beneficial in this case?
Given that I have not had the opportunity to examine your condition directly, it is difficult to provide definitive answers.
I recommend consulting with a physician for a thorough evaluation.
Best regards,
Dr.
Lai Yi-Cheng
Changhua Hospital

Reply Date: 2016/04/21

More Info

When it comes to lymphatic swelling in the neck, particularly in your case where you have observed a lymph node enlargement on the left side of your neck for three years without significant changes, it is important to consider several factors before jumping to conclusions about potential underlying conditions.

Firstly, lymph nodes can swell for a variety of reasons, including infections, inflammatory conditions, or malignancies. In your case, the fact that the swelling has remained stable over three years, is soft to the touch, and has not been associated with systemic symptoms such as fever, weight loss, or fatigue is reassuring. These factors suggest that the likelihood of a malignant process, such as lymphoma, is lower, but it cannot be completely ruled out without further investigation.

Given that you have undergone regular monitoring through blood tests, ultrasounds, and nasal endoscopy, and all results have been normal, it seems that your healthcare providers are taking a cautious approach. The recommendation to continue observation is common in cases where there are no alarming features. However, your concern about the possibility of a more serious condition, such as a tumor, is valid, especially since you have a history of oral lesions that required treatment.

In terms of next steps, your inclination to pursue further diagnostic testing, such as a CT scan or a biopsy, is reasonable, especially if you are experiencing discomfort or if there are any changes in the characteristics of the lymph node. A CT scan can provide a more detailed view of the lymphatic structures and help identify any abnormalities that may not be visible on ultrasound. A biopsy, whether through fine needle aspiration or excisional biopsy, can provide definitive information regarding the nature of the lymphatic swelling.

Regarding your question about treatment, if the lymphatic swelling is determined to be benign but symptomatic, treatment options may include observation, physical therapy, or in some cases, surgical intervention. Lymph node removal (lymphadenectomy) is typically reserved for cases where there is a suspicion of malignancy or if the lymph nodes are causing significant symptoms. However, this decision should be made in consultation with a healthcare provider who specializes in head and neck surgery or oncology.

In conclusion, while the stability of your lymphatic swelling over three years is reassuring, your proactive approach to seeking further evaluation is commendable. Discussing your concerns with your healthcare provider and considering additional imaging or biopsy can help clarify the situation. It is essential to weigh the risks and benefits of any potential interventions, and your healthcare team can guide you through this process. Remember, early detection and accurate diagnosis are key in managing any health concerns effectively.

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